Duration Of Urticaria Research Articles

Clinical Features and Outcomes of Acute versus Chronic Urticaria Triggered by COVID-19 Infection.

Although acute urticaria (AU) and urticaria-like rash are commonly reported with COVID-19 infection, chronic spontaneous urticaria (CSU) triggered by COVID-19 is rare. The authors compared the features of COVID-19 infection-induced chronic CSU and AU to determine which patients' COVID-19 infection leads to CSU and possible indicators of chronicity. The authors retrieved the charts of patients diagnosed with AU or CSU following COVID-19 at the Urticaria Centers of Reference and Excellence and compared patients in terms of demographic characteristics, length of time between infection and onset of urticaria, duration of urticaria, COVID-19 disease severity, laboratory test results, vaccination, and treatment status. A total of 92 patients were included in the study: 7 with CSU following COVID-19 and 85 with AU after COVID-19. The mean duration of urticaria for CSU and AU following COVID-19 was 13.0 ± 6.0 months and 7.1 ± 3.4 days, respectively. The average time between COVID-19 and the start of urticaria was longer in the CSU group (20.7 ± 3.9 days vs 4.5 ± 2.8 days, respectively; P = .000). No between-group differences were found for any other parameters. The onset of urticaria more than 2 weeks after COVID-19 infection may serve as an indicator for urticaria chronicity beyond 6 weeks and may help physicians predict the possible course of urticaria associated with COVID-19 infection. The relevance of basopenia and eosinopenia needs to be determined.

Evaluation of Serum Cathelicidin in Patients with Chronic Spontaneous Urticaria

Abstract Background Chronic spontaneous urticaria (CSU) has long been recognized as a major clinical problem with unknown cause, and it is well known that part of it is autoimmune. Cathelicidin as antimicrobial peptides was linked to autoimmune diseases. So, this study will be conducted as a step forward for better understanding of (CSU) pathophysiology. Aim of the Work Assessment of Serum Cathelicidin levels in patients with chronic spontaneous urticarial and correlate Serum Cathelicidin with Urticaria Activity Score. Patients and Methods This was a case control study conducted on 40 patients with chronic spontaneous urticaria attending the outpatient allergy and immunology clinic at Ain Shams University hospitals between October 2020 and August 2021 with 40 controls with matched age and sex were also included to evaluate serum Cathelicidin in patients with chronic spontaneous urticaria. Results The mean age of our CSU patients was 36.88 years; 67.5% were female. These demographic data are consistent with those of the literature. Our results showed that the distribution of the studied cases regarding demographic data, family history and duration of urticaria was no statistically significant difference between studied groups regarding sex, age. While for the family history there were 36 negative cases and only 4 had positive history. Regarding lab tests, we found that there was statistically significant difference between the studied Groups as regard the following WBC: (p value 0.023) being higher in group of patients than group of control, while for Total IgE: (p value <0.001) was being higher in group of patients than group of control. Also showed that there is no statistically significant difference between studied Groups regarding Hemoglobin, Plts, Eosinophils, with p value (0.056,0.989,0.411) respectively. The distribution of the studied cases according to Urticaria activity score (UAS7) in patients group was demonstrated as 12.5 % in Score 1, 50 % in score 2, 37.5 % in score 3. Conclusion Chronic spontaneous urticaria (CSU) has long been recognized as a major clinical problem with unknown cause, and it is well known that part of it is autoimmune. Cathelicidin as antimicrobial peptides was linked to autoimmune diseases. So, this study was conducted as a step forward for better understanding of (CSU) pathophysiology.

Detection of serum IgG autoantibodies to FcεRIα by ELISA in patients with chronic spontaneous urticaria.

Mast cells are a key effector cell in the pathogenesis of chronic spontaneous urticaria (CSU) and activated by circulating FcεRI-specific IgG as well as IgE. This study evaluated the prevalence of circulating autoantibodies to FcεRIα in the sera of CSU patients. Eighty-eight patients with CSU and 76 healthy controls (HCs) were enrolled. To detect circulating autoantibodies (IgG/IgA/IgM) to FcεRIα, ELISA was done using YH35324 (as a solid phase antigen), and its binding specificity was confirmed by the ELISA inhibition test. The antibody levels were presented by the ratio of YH35324-preincubated to mock-preincubated absorbance values. Clinical and autoimmune parameters, including atopy, urticaria activity score (UAS), serum total/free IgE levels, serum antinuclear antibody (ANA) and autologous serum skin test (ASST) results, were assessed. The autoimmune group was defined if CSU patients had positive results to ASST and/or ANA. The ratio of serum IgG to FcεRIα was significantly lower in CSU patients than in HCs (P<0.05), while no differences were noted in serum levels of IgG to recombinant FcεRIα or IgA/IgM autoantibodies. The autoimmune CSU group had significantly lower ratios of IgG/IgA (not IgM) autoantibodies to FcεRIα than the nonautoimmune CSU group (P<0.05 for each). No significant associations were found between sex, age, atopy, urticaria duration, UAS, or serum total/free IgE levels according to the presence of IgG/IgA/IgM antibodies. This study confirmed the presence of IgG to FcεRIα in the sera of CSU patients, especially those with the autoimmune phenotype.

Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria.

In this study, we aimed to evaluate the sleep quality among chronic urticaria patients using the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL), sleep quality assessment tools, and polysomnography and to investigate any relationships between the obtained results. The study included 21 patients diagnosed with chronic spontaneous urticaria and 19 healthy controls. We recorded the patients' sleep quality data, including CU-Q2 oL, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and polysomnography results. Patients in the chronic urticaria group were more likely to have an ESS score of ≥10 (52.4% vs. 5.3%, p=0.004) and an apnea-hypopnea index of ≥5 (44.4% vs. 5.3%, p=0.017) compared to the control group. In the patient group, the CU-Q2 oL total score was positively correlated with sleep latency (r=0.713, p=0.004) and PSQI-C1 score (r=0.726, p=0.005), while it was negatively correlated with urticaria duration (r=-0.579, p=0.015), apnea-hypopnea index (r=-0.607, p=0.021), longest apnea duration (r=-0.583, p=0.029), total number of respiratory events (r=-0.618, p=0.018), and apnea count (r=-0.686, p=0.007). We conclude that sleep-related problems exist among a considerably large proportion of patients with chronic spontaneous urticaria.

Increased serum free IgE levels in patients with chronic spontaneous urticaria (CSU).

BackgroundIgE bound on the surface of mast cells contributes to the pathogenesis of chronic spontaneous urticaria (CSU). Atopy is a predisposing factor for CSU, where omalizumab is a widely used monoclonal antibody to control urticaria symptoms via capturing serum free IgE. However, the role of serum free IgE is not clarified in CSU. The present study evaluated the clinical relevance of serum free IgE in patients with CSU.MethodsEighty-eight patients with CSU and 76 healthy controls (HCs) were enrolled in this study. Serum total and Dermatophagoides pteronyssinus (Der p)-specific IgE levels were measured by ImmunoCAPs. The serum free IgE levels were measured by ELISA using a novel IgETRAP, and their associations with clinical parameters, including urticaria activity score (UAS), were evaluated. Changes in serum free and total IgE levels after omalizumab treatment were observed in 23 CSU patients in comparison between responders (≥50% reduction in UAS) and non-responders (<50% reduction).ResultsSignificantly higher serum free/total IgE levels were noted in CSU patients than in HCs with a positive correlation between the 2 values (rho = 0.87, P < 0.001). Among CSU patients, atopics had significantly higher serum free IgE levels than non-atopics, while no associations were noted with UAS, urticaria duration, or the results of serum ANA or autologous serum skin tests. In addition, there were no significant changes in serum free IgE levels during 12 months of omalizumab treatment. No significant differences were noted in serum free/total IgE levels or clinical parameters between responders and non-responders, while responders have higher serum Der p-specific IgE level and its ratio to serum free/total IgE level than non-responders (P < 0.05, respectively).ConclusionsThese findings suggest that increased serum free IgE may be involved in the development of CSU by activating mast cells, especially in atopics. High Der p-specific IgE level and its ratio to serum free IgE level may be a potential biomarker for predicting favorable responses to omalizumab in CSU.

An evaluation of the factors affecting the clinical and laboratory findings, prognosis, and treatment response in children with chronic urticaria.

Chronic urticaria (CU) is a rare disease in childhood, and studies in children are limited. In this study, the aim was to investigate the clinical and laboratory findings and demographic characteristics of children with CU and to determine the factors affecting prognosis. The study included 141 patients aged 0-18 years who were diagnosed with CU in the pediatric allergy outpatient clinic between January 1, 2013, and December 31, 2018. Risk factors related to prognosis were investigated by comparing the duration of CU and treatment response with clinical and etiological features. IBM SPSS version 24 was used for statistical analyses. In the study group, the female/male ratio was 69/55, and the median age at first visit was 9.5 years (min:1, max:17). Among patients, 63 (44.5%) had an accompanying atopic disease, and 23 (16.3%) had chronic disease. Of the patients, 124 (88%) had chronic spontaneous urticaria, and 17 patients (12%) had chronic inducible urticaria (CIU). Of those with CIU, 72.2% had symptomatic dermographism, 16.7% had cholinergic urticaria, and 11.1% had cold urticaria. After the evaluations, the most common pathological findings in our patients were intestinal parasitosis (n=14), anemia (n=10), and urinary tract infection (n=8). The median total duration of urticaria was 47 weeks (min:8, max:284). The duration of urticaria was longer in patients with atopy (p < 0.05), and the group that went into remission with standard-dose antihistamine was the group with highest eosinophil count (p=0.022). In most children with CU, the underlying cause/disease cannot be determined. In our study, treatable triggers were found in some of the patients. Therefore, it is appropriate for each patient to be evaluated with selected laboratory tests after detailed history and physical examination.

STUDY OF THE CLINICAL CHARACTERISTICS OF INDIVIDUALS WITH CHRONIC URTICARIA: A CROSS SECTIONAL STUDY

Introduction: Because of its continuous relapsing pattern and poor response to medication, chronic urticaria has a detrimental impact on sufferers' professional and social lives. Despite research improvements, the origin and cause of the varied intensity and frequency of clinical manifestation remains a mystery. Aim: The goal of this study was to look at the clinical profile of chronic urticaria in a tertiary care setting. Methods: The study comprised patients of both sexes aged 12 to 60 years old with a clinical diagnosis of chronic urticaria for which no cause could be identified using a standard technique. Results: The average age of the patients with chronic urticaria was 30.44 years, and females predominated, with a male to female ratio of 1:3. The average duration of urticaria was 27.84 months, and urticaria lesions disappeared in less than 30 minutes in 48% of patients. In 38 percent of cases, there was accompanied angioedema, and in 46 percent, there was delayed pressure urticaria. Limitations: The study's sample size was tiny, which constituted a constraint. Conclusions: Our study's clinical profile of chronic idiopathic urticaria is comparable to that of prior research. Keywords: Chronic urticaria, chronic idiopathic urticaria, chronic spontaneous urticaria

Cold Agglutinins and Cryoglobulins Associate With Clinical and Laboratory Parameters of Cold Urticaria.

Mast cell-activating signals in cold urticaria are not yet well defined and are likely to be heterogeneous. Cold agglutinins and cryoglobulins have been described as factors possibly associated with cold urticaria, but their relevance has not been explained. We performed a single-center prospective cohort study of 35 cold urticaria patients. Cold agglutinin and cryoglobulin test results, demographics, detailed history data, cold stimulation test results, complete blood count values, C-reactive protein, total immunoglobulin E levels, and basal serum tryptase levels were analyzed. Forty six percent (n = 16) of 35 tested patients had a positive cold agglutinin test and 27% (n = 9) of 33 tested patients had a positive cryoglobulin test. Cold agglutinin positive patients, when compared to cold agglutinin negative ones, were mainly female (P = 0.030). No gender-association was found for cryoglobulins. A positive cold agglutinin test, but not a positive cryoglobulin test, was associated with a higher rate of reactions triggered by cold ambient air (P = 0.009) or immersion in cold water (P = 0.041), and aggravated by increased summer humidity (P = 0.007). Additionally, patients with a positive cold agglutinin test had a higher frequency of angioedema triggered by ingestion of cold foods or drinks (P = 0.043), and lower disease control based on Urticaria Control Test (P = 0.023). Cold agglutinin levels correlated with erythrocyte counts (r = −0.372, P = 0.028) and monocyte counts (r = −0.425, P = 0.011). Cryoglobulin concentrations correlated with basal serum tryptase levels (r = 0.733, P = 0.025) and cold urticaria duration (r = 0.683, P = 0.042). Results of our study suggest that cold agglutinins and cryoglobulins, in a subpopulation of cold urticaria patients, are linked to the course and possibly the pathogenesis of their disease.

Comorbidities in Patients with Chronic Urticaria

Several comorbidities are frequently associated with chronic urticaria (CU), and some can cause worse prognosis to the disease. The objective was to describe the frequency of comorbidities in patients with CU. This is a retrospective study with data collected from electronic medical records of patients with CU followed up in a tertiary service. Epidemiological data, CU’s classification, frequency of comorbidities were analyzed: esophagitis/gastritis, obesity, systemic arterial hypertension, diabetes mellitus, thyroid diseases, respiratory diseases (rhinitis and/or asthma) and psychological diseases; the frequency of angioedema (AE), exacerbation by NSAIDs and refractoriness to H1 antihistamines. Patients were classified according to the concomitance of comorbidities. There were 102 sequentially selected patients. Respiratory diseases were the most frequent comorbidity (42.2%), followed by systemic arterial hypertension (26.5%). When patients were classified according to the their frequency of comorbidities, there was no statistical difference in relation to the frequency of angioedema, exacerbation by NSAIDs or refractiveness to antihistamines. The greater the number of comorbidities, the greater the number of each disease, progressively, except for thyroid disease and psychic conditions. The group with four or more comorbidities had a higher mean age (57.3 years), longer urticaria time (12.8 years) and greater refractoriness to antihistamines (54.5%). Patients with multiple comorbidities were older, had longer urticaria duration and were more refractory to antihistamines, which may indicate worse prognosis. The progressive increase in the number of comorbidities, in the same patient, favors the hypothesis of CU to behave as a low-grade systemic inflammatory disease.

Clinical Characteristics of Patients with Chronic Urticaria and Adherence to Management Guidelines by Postgraduate Students in Dermatology: A Retrospective Single Center Study.

Background:Chronic urticaria is a heterogenous skin disorder representing one of the important reasons for consultation with a dermatologist. Dermatology post-graduate students play an importanrt role in the treatment of patients with chronic urticaria.Objective:The objective of the study was to describe clinical characteristics of patients with chronic urticaria and assess adherence to the guidelines by postgraduate students in the department of dermatology of a tertiary care center.Materials and Methods:In this retrospective study, prescriptions of patients with chronic urticaria and/or angioedema presenting to the outpatient department for 5 months were analyzed. Percentage of prescriptions adhering to international urticaria management guidelines was calculated. Urticaria Activity Score, percentage of patients receiving second-generation antihistamines, first-generation antihistamines, and other drugs was recorded. Comorbidities in patients with chronic urticaria were also noted.Results:A total of 60 patients (mean age 32.1 years; 58.3% male) were included in. Mean (SD) duration of urticaria at the time of study was 4.7 (2.7) months. Demographism and history of allergy to drugs was present in 45 (75%) and 4 (6.7%) patients. Mean (SD) Urticaria Activity Score was 12.5 (6.5). A total of 12 (20%) patients had comorbidities. Mean number of drugs received per patient was 1.7 (0.5). A total of 47 (78.3%) patients received second-generation antihistamines, whereas 11 (18.3%) received first-generation antihistamines. Two (3.3%) patients received combination of first-generation and second-generation antihistamines. Fexofenadine, levocetirizine, bilastine, and cetirizine was prescribed to 24 (40%), 26 (43.3%), 18 (30%), and 14 (23.3%) patients. There was no significant difference in male and female patients receiving fexofenadine (P = 0.59) or levocetirizine (P = 0.13).Conclusion:Adherence to urticaria management guidelines by resident doctors in dermatology department in our institute was satisfactory.

Elevated MRGPRX2 Levels Related to Disease Severity in Patients With Chronic Spontaneous Urticaria.

Mas-related G-protein coupled receptor-X2 (MRGPRX2), a receptor on mast cells, basophils, and eosinophils associated with immunoglobulin E (IgE)-independent degranulation, has been reported to be highly expressed on cutaneous mast cells in patients with severe chronic spontaneous urticaria (CSU). We sought to investigate whether MRGPRX2 levels in the sera from CSU patients differ from those in healthy control subjects and to evaluate the clinical utility of MRGPRX2 levels in CSU patients. Severe CSU was defined as urticaria activity score over 7 days (UAS7) ≥ 28. Serum samples from 116 (73 severe and 43 non-severe) CSU patients and 50 healthy subjects were screened for MRGPRX2 using enzyme-linked immunosorbent assay. Serum MRGPRX2 levels were significantly higher in patients with severe CSU (median [interquartile range], 16.5 [10.8–24.8]) than in healthy controls (11.7 [6.5–21.2], P = 0.036) and in non-severe CSU patients (8.7 [4.5–18.8], P = 0.002), although they did not differ between healthy subjects and non-severe CSU patients. Serum MRGPRX2 levels in CSU patients showed positive correlations with UAS7 and specific IgE against Dermatophagoides farinae in CSU subjects, whereas no correlations were observed for age, sex, urticaria duration, atopy, combined angioedema, autologous serum skin test positivity, or total IgE levels. Logistic regression analysis identified serum MRGPRX2 ≥ 12 ng/mL (odds ratio, 6.421; P = 0.002) as an independent risk factor for severe CSU, along with increased serum total IgE levels, peripheral basophil percentage, and angioedema. In conclusion, we suggest that serum MRGPRX2 could help indicate severe CSU.

Comparative analysis of clinical and laboratory parameters of autoimmune and idiopathic chronic urticaria patients

Background: According to the cause, chronic urticaria is most frequently divided into autoimmune and idiopathic urticaria. Aim of the paper was to determine the frequency of autoimmune urticaria using autologous serum skin testing and a comparative analysis of chronic idiopathic and chronic autoimmune urticaria by disease course, severity and most common comorbidities. Methods: Analysis covered 64 adult patients of both sexes with chronic urticaria, divided into two groups according to their positivity in autologous serum skin testing (group I with positive test and group II with negative test). General haematological and biochemical parameters, antithyroid antibodies, hepatitis serum markers, Helicobacter pylori and Borrelia burgdorferi antibodies were performed for patients in both groups. First group patients were treated by autologous blood therapy (autohaemotherapy). The analytical statistical tool SPSS (Statistical Product and Service Solutions) version 20 for descriptive statistics and statistical methods was used. The significance level used was p = 0.05. Results: The frequency of positive autologous serum test in total population of patients with chronic urticaria was 43.8 %. The average duration of urticaria was 20 months in both groups. Statistically significant difference was found in weekly scores between the studied groups (p = 0.032) in favour of chronic autoimmune urticaria with a positive autologous serum test. Subjects with chronic autoimmune urticaria had a significantly higher association with autoimmune thyroid diseases. Conclusions: Direct relation was established between the use of autologous blood therapy in patients with autoimmune chronic urticaria and improvement of the clinical picture.

Global Epidemiology of Urticaria: Increasing Burden among Children, Females and Low-income Regions.

Urticaria has a high socioeconomic burden worldwide. However, the global epidemiology of urticaria and its geographical and temporal trends are not well studied. Using the Global Burden of Disease dataset, the aim of this study was to analyse the age-standardized prevalence, incidence, years lived with disability, and mean duration of urticaria in 195 countries from 1990 to 2017. In addition, the relationship between socioeconomic development and urticaria was evaluated. The global prevalence of urticaria in 2017 was 86 million people. Females and children aged 1–4 years were more commonly affected than males and adults, respectively: these differences were outside the 95% uncertainty intervals. Regression analyses showed that a lower gross domestic product per capita was associated with a higher prevalence and incidence of urticaria (p < 0.001). The global prevalence of urticaria, incidence, and years lived with disability have remained stable from 1990 to 2017.

Experience with Omalizumab for the treatment of chronic spontaneous urticaria in a tertiary center: real life experience

Purpose Chronic spontaneous urticaria (CSU) is defined as urticaria and/or angioedema that appears spontaneously due to known or unknown causes and lasts for at least 6 weeks. Omalizumab, an anti-IgE antibody that binds circulating free IgE, has recently emerged as a promising treatment for CSU, a condition which impairs patients’ quality of life. We aimed to contribute real life data by reporting our experience with omalizumab in the treatment of intractable CSU. Methods Of 140 patients treated with omalizumab in our clinic between September 2013 and January 2018, 86 CSU patients with available current data were retrospectively evaluated in terms of sex, age, urticaria duration, urticaria activity score over 7 days (UAS7) before and after omalizumab, relapses and time to relapse, length of remission after omalizumab cessation, adverse events, and comorbidities. Results The mean age of the patients was 45.5 ± 14.3 years and 73.3% were women. Mean duration of urticaria before initiation of omalizumab therapy was 54.5 ± 67 months. All patients had used antihistamines before starting omalizumab treatment. The mean number of omalizumab doses was 11.9 ± 9.3. The mean duration of omalizumab treatment was 13.3 ± 10.4 months. Mean UAS7 score was 38.9 ± 4.1 before the start of omalizumab treatment, and 7.9 ± 10.5 after treatment. Treatment was discontinued in 10 patients (11.6%) due to nonresponse or loss of effect. Four patients (4.65%) experienced adverse events. Treatment was discontinued in 1 patient (1.16%) due to side effects. Of the 55 patients whose treatment was discontinued after their symptoms resolved, 31 (56.3%) relapsed after omalizumab cessation. Twenty-four patients (43.6%) did not relapse after omalizumab cessation. Conclusions Our results show that omalizumab was an effective treatment for intractable CSU and did not cause any serious adverse effects other than asthenia, vertigo, and injection site reaction in four patients. These findings are relevant because they reflect real-life data.

Omalizumab treatment in adolescents with chronic spontaneous urticaria: Efficacy and safety

BackgroundOmalizumab is useful as an add-on treatment in patients unresponsive to high doses of second-generation antihistamines. This study aimed to evaluate the efficacy and safety of omalizumab treatment in adolescents with refractory chronic spontaneous urticaria (CSU). MethodsCSU patients aged 12–18 years old with the diagnosis of symptomatic CSU and unresponsive to classical treatment were included in the study. All patients had an urticaria-activity-score (UAS7) of ≥16 or and were treated with 300mg omalizumab every four weeks. The degree of response was classified into complete, partial and non-responders due to UAS7. ResultsA total of 29 patients were evaluated. The median age and symptom onset age of the patients was 15.2 (IQR, 12.8–16.5) years and 14.0 (IQR, 11.8–15.9) years, respectively. The median duration of urticaria was eight (IQR, 4–24) months at admission. Eleven (37.9%) patients had angioedema and ten (34.5%) patients had concomitant allergic diseases. The median age at the beginning of treatment with omalizumab was 15.4 (IQR, 12.9–16.9) years. The median symptom duration was 12 (IQR, 6.5–27.5) months before the omalizumab treatment. Twenty-eight (96.5%) of the patients (89.6% complete, 6.9% partial) achieved response; however, one patient was a non-responder (3.5%). The adverse effect was observed in one (3.4%) patient as angioedema after the third dose. Twenty-three patients were followed up for a median of 18 (IQR, 13–27) months. Relapse was observed in three (13%) patients. ConclusionsOmalizumab is considered as an effective and safe treatment for CSU in adolescents. Relapses mostly occur within the first year after the cessation of treatment.

Health-Related Utility of EQ-5D in Korean Adults With Chronic Urticaria: Mapping From Urticaria Outcome Measures.

PurposeA need for useful measures reflective of the socio-economic burden of chronic urticaria (CU) has arisen. To obtain utility estimates for CU, we investigated EuroQol-5-Dimension (EQ-5D) indices according to urticaria control status and urticaria severity.MethodsIn this prospective observational study, we administered patient-oriented questionnaires on EQ-5D and urticaria outcomes, including Urticaria Activity Score over 7 days (UAS7), Urticaria Control Test (UCT), and CU-specific quality of life (CU-QOL). EQ-5D utility index scores were compared according to urticaria control status and disease severity. Conditional process analysis (CPA) was used to map EQ-5D utility scores from UAS7 and UCT.ResultsGreater EQ-5D utility values were obtained in patients with better urticaria control (0.91 ± 0.10 for well controlled CU, 0.84 ± 0.12 for partly controlled, 0.77 ± 0.14 for uncontrolled, P < 0.001). According to CU severity, mean utility values were ranged from 0.746 (severe, UAS7 ≥ 28) to 0.860 (moderate), 0.878 (mild), and 0.953 (urticaria free). CPA suggested that UAS7 was directly correlated with UCT (regression coefficient, −0.251; 95% confidence interval [CI], −0.278, −0.223; P < 0.001) and EQ-5D utility (−0.002; 95% CI, −0.003, −0.001; P = 0.007) after controlling for age, sex, urticaria duration, and combined allergic diseases.ConclusionsEQ-5D values increased with improvement in urticaria control and decreased with urticaria severity. A predictive model mapping EQ-5D utility from UAS7 and UCT scores suggested that EQ-5D can be useful for the pharmacoeconomic evaluation of individualized treatments for CU patients.

Etiology and immediate drug hypersensitivity in acute urticaria: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acute urticaria is an immune mediated or non-immune reaction lasting for less than 6 weeks. This can be caused by food, drugs, infections, physical contact, insect bite but majority are reported to be idiopathic. Theoretically, almost any drug can cause urticaria especially antibiotics like penicillin. We carried out this study to assess the various etiologial factors and to assess the immediate hypersensitivity reaction to various drugs in acute urticaria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We reviewed the medical records of patients with acute urticaria in dermatology department from 2016 to 2018 (2 years) and recorded the demographic details, history of suspected cause, medications and intradermal drug test report in a standard proforma.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 154 cases of acute urticaria. Mean age of these cases were 36.48±11.37 years. 13.6% had associated angioedema. Mean duration of urticaria was 21.74±7.92 days. 40.9% cases were labelled idiopathic. Food accounted for 29.2% of the cases, drugs for 23.4% and infection for 5.2%. The rest 1.3% were due to insect bite. Intradermal drug test report showed the following frequency of positive reaction: diclofenac&amp;gt;ciprofloxacin= piroxicam&amp;gt;paracetamol=ketamine=diazepam&amp;gt;promethazine=atracurium.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most cases of acute urticaria were idiopathic whereas food, drugs, infections and insect bite were the specific causes. Fish among food, acetaminophen among drugs and streptococci among infections were most responsible agents. Immediate hypersensitivity to drugs in intradermal test were maximum for NSAIDs especially diclofenac and piroxicam followed by antibiotic namely ciprofloxacin in patients with acute urticaria.&lt;/p&gt;

Predictive factors for progression to chronicity or recurrence after the first attack of acute urticaria in preschool-age children

Introduction and objectivesPreschool-aged group is frequently affected by urticaria, and infections are the most frequently documented factors that cause acute urticaria in children. This prospective study was designed to investigate the underlying factors of acute urticaria in under five-year-old children and to describe predictive factors for progression to chronicity or recurrence after the first attack. Patients and methodsChildren younger than five years of age with acute urticaria were recruited between July 2015 and July 2016. Patients (n=83) were grouped into those below and above two years of age. In order to assess the risk factors for progression to chronicity or recurrence, logistic regression analysis was performed. ResultsUpper respiratory tract infection was the most common detectable reason for acute urticaria (49.4%). Herpes Simplex Virus type 1 was significantly isolated in the cases with the manifestation of an acute single-episode urticaria (p=0.042). Angioedema and food allergy were predominantly observed under two years old (p=0.001, p=0.006 respectively). A positive relationship was determined between the duration of urticaria and chronicity (r=0.301, p=0.006). The absence of atopic dermatitis (OR: 6.95, 95% CI: 1.35–35.67, p=0.020), negative Herpes virus serology (OR: 4.25, 95% CI: 0.83–21.56, p=0.040), and unknown etiology (OR: 3.30, 95% CI: 1.12–9.71, p=0.030) were the independent risk factors for recurrent urticaria. ConclusionsPreschool-aged children with acute urticaria should be evaluated for infections at the time of admission. Patients with unknown etiology, negative Herpes virus serology, absence of atopic dermatitis, and long lasting urticaria should be followed up for chronicity and recurrence.

Headache deteriorates the quality of life in children with chronic spontaneous urticaria

BackgroundQuality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU. ObjectivesTo investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU. MethodsA total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied. ResultsCU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p=0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p=0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p<0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT. ConclusionHeadache may be an important factor that affects and impairs quality of life in children with chronic urticaria.

Pattern of chronic urticaria and value of autologous serum skin test in Sohag Province, Upper Egypt.

BackgroundChronic urticaria (CU) is a debilitating disorder with variable clinical course. It is characterized by hives occurring for at least 6 weeks, and is classified as spontaneous or inducible.ObjectiveThe aim of this study was to detect the pattern of CU, to study association between results of autologous serum skin test (ASST) and urticaria severity score (USS), and to detect serum levels of anti IgE receptors antibodies.MethodsThis study included all patients attending the Dermatology Outpatient Clinic, Sohag University Hospital, who were diagnosed as CU from April 2015 to March 2016. ASST and serum level of anti IgE receptor antibodies was assessed using ELISA. Data were analyzed by SPSS version 16, using descriptive statistics, Kruskal-Wallis and Mann-Whitney U test.ResultsA total of 108 patients with CU were included in the study. Females with mean age 33±12.4 years were more affected. A total of 58.3% complained of CSU, 6.5% physical urticaria and 35.2% mixed type of CU. According to USS, mild score represented 20.4%, moderate 46.3% and severe in 33.3%. ASST showed positive in 38% of patients. There was a statistically significant relation between ASST and USS and duration of CU. This indicates that more severe symptoms and prolonged duration of CU are observed in positive ASST (autoreactive type). In all, 91% of the anti IgE receptor antibodies positive patients had positive ASST.ConclusionIn conclusion, chronic urticaria is not an uncommon disease in our locality which represented 1.13% of our patients. Urticaria severity score and duration of urticaria was higher in positive ASST patients and hence the autoreactive type.